Investigation of patient blood management in colorectal surgery

• Main Author: Keeler, Barrie D.
• Published: University of Nottingham 2016
• Subjects: 617.5; WI Digestive system
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.689938

Introduction: Perioperative allogeneic red blood transfusions (ARBT) are associated with impaired short and long term outcomes. Consequently, perioperative ARBT should be avoided, yet preoperative anaemia increases this need. The study aimed to compare the efficacy of preoperative intravenous (IVI) and oral iron (OI) in reducing ARBT use in anaemic patients undergoing colorectal cancer (CRC) surgery. Methods: 116 anaemic patients with non-metastatic CRC adenocarcinoma were recruited preoperatively and randomised to receive either OI (ferrous sulphate) or IVI (ferric carboxymaltose). Perioperative changes in Haemoglobin (HB) and ARBT were recorded across groups. Parametric data was compared with 2 tailed T-test and non-parametric paired data with Wilcoxon Rank test, and Mann-Whitney U test. Nominal data was compared with 2-tailed Chi squared test. Results: There was no difference in demographic data between groups. HB levels at recruitment were comparable (OI 10.4g/dL 95%CI 10.1-10.7; IVI 10.2g/dL 95%CI 9.8-10.5, P=0.24), as was median treatment duration (OI 21 days IQR 15-33; IVI 21 days IQR 15-34, P=0.75). However, HB levels were higher on the day of Surgery in IVI (11.9g/dL 95%CI 11.5-12.3 vs OI 11g/dL 95%CI 10.6-11.4, P<0.01). Median preoperative HB change in patients not transfused preoperatively was higher in IVI (1.5g/dL IQR 0.9-2.6 vs OI 0.5g/dL IQR-0.1-1.3, P<0.01). There were fewer anaemic patients at surgery in the IVI group after treatment (75% vs 90%, P<0.05). OI patients received a mean 0.63u (95%CI 0.26-1) from recruitment to day 28 postoperatively vs mean 0.47u (95%CI 0.1-0.84) for IVI. Neither number of patients transfused (P=0.33) nor mean units transfused (P=0.54) differed over this period. When patients with heavy intraoperative losses (>1.5L) were excluded in subgroup analysis, a significant difference in mean units of blood transfused was seen up to 7 days post operatively (n= 108; OI 0.6u 95%CI 0.23-0.96; IVI 0.16u 95%CI 0.01-0.3, P< 0.05) and significantly less IVI patients were transfused (10% vs 25%, P<0.05) Conclusions: In patients undergoing CRC surgery, IVI appears more efficacious than OI at treating preoperative anaemia. It does not appear to minimise overall ARBT requirement, but may reduce ARBT use in the immediate perioperative period when the implications of ARBT are probably at their greatest.